Outcomes of Drug and Alcohol Treatment among American Indians in California

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Outcomes of Drug and Alcohol Treatment among
American Indians in California

• Suzanne Spear
• Semel Institute for Neuroscience and Human
  Behavior
• David Geffen School of Medicine
• University of California at Los Angeles
• www.uclaisap.org
• sspear_at_ucla.edu

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Health disparities among American Indians (AIs)

• Rates of substance dependence and abuse among
  persons age 12 and older are highest among AIs
  (14.1 percent)
• Rates of illicit drug use (10.1 percent), alcohol
  (44.7 percent) and binge alcohol use (27.9
  percent) are among the highest in the nation
• AIs die at higher rates than other Americans from
  alcoholism (770 percent)

Source US Dept Health and Human Services, 2003
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California Treatment Outcomes Project (CalTOP)

• Large, multi-site study of treatment client
  outcomes in CA (2000-2002)
• Created an outcomes monitoring system in CA
• Run by researchers at Integrated Substance Abuse
  Programs
• Afforded opportunity to study substance abuse
  patterns among AI/AN adults

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Research Questions

• Aside from race/ethnicity, are AIs different from
  non-AIs at treatment entry on general
  characteristics and problem severity?
• How do substance abuse treatment outcomes differ
  among AIs and non-AIs?

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Methods

• Secondary analysis of 368 AI patients and an
  equal number of non-AIs
• matched in terms of treatment provider, primary
  drug problem, sex, and age 3 years
• from 39 outpatient and residential treatment
  programs in 13 California counties who
  participated in CalTOP (El Dorado, San Diego, San
  Joaquin w/ highest numbers)

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Methods

• Patients assessed at
• Admission Addiction Severity Index Lite
• Discharge Status and time in treatment
• 3 months after admission Treatment Services
  Review and Treatment Satisfaction
• 9 months after admission Addiction Severity
  Index Lite
• 12 months after admission official records on
  arrests, driving while under the influence of
  alcohol or drugs, and mental health care
• Logistic regression models to examine differences
  in outcomes

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Patient characteristics at admission
a AIs and CalTOP, plt0.05 b Non-AIs and CalTOP,
plt0.05 c AIs and non-AIs, plt0.05.
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Patient characteristics at admission, cont.
a AIs and CalTOP, plt0.05 b Non-AIs and CalTOP,
plt0.05 c AIs and non-AIs, plt0.05.
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Mean number of treatment days by modality
Treatment days
lt0.01
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Treatment intensity All services received
Mean number of services received
t test on differences were significant when
comparing AIs and non-AIs, plt0.05.
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Treatment intensity All alcohol services received
Mean number of services received
t test on differences were significant when
comparing AIs and non-AIs, plt0.05.
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Treatment intensityAll individual sessions
received
Mean number of services received
t test on differences were significant when
comparing AIs and non-AIs, plt0.05
13
Treatment intensity Alcohol individual sessions
received
Mean number of services received
t test on differences were significant when
comparing AIs and non-AIs, plt0.05 plt0.01.
14
Treatment intensity Psychiatric group sessions
received
Mean number of services received
t test on differences were significant when
comparing AIs and non-AIs, plt0.05.
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Decrease in problem severityfrom admission to
9-month follow-up
Mean pre-post change in ASI scores
ANCOVA test on ASI composite scores at follow-up
controlling for score at admission found no
significant differences between AIs and non-AIs,
plt0.05.
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Improvements for AIs (before vs. after treatment)

• Past 30 day use, 31.2 vs. 16.9
• Alcohol use to intoxication, 23.4 vs. 7.7
• Problems related to alcohol, 48.8 vs. 13.9
• 3.8 increase in mental health services
• 14.7 less arrests
• Lot less DUIs (7 vs. 1.8)

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Logistic regression models predicting arrests,
DUIs, and mental health services utilization
during 12-mo post treatment admission
plt0.05, plt0.01
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Logistic regression models predicting arrests,
DUIs, and mental health services utilization
during 12-mo post treatment admission, cont.
plt0.05, plt0.01
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Results summary

• Pretreatment problems were similarly severe among
  AIs and non-AIs
• About half in both groups either completed
  treatment or stayed in treatment more than 90
  days AIs in residential care had significantly
  shorter treatment retention
• AIs received fewer individual sessions and
  out-of-program services, especially for alcohol
  abuse, but were nevertheless generally satisfied
  with their treatment

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Results summary

• Alcohol abuse and related problems among AIs were
  reduced as a result of treatment
• AIs in residential received less referrals to
  outside services for alcohol
• Service intensity was associated with retention
  for AIs in residential
• Both groups improved after treatment, with AIs
  demonstrating greater reductions in arrests than
  non-AIs

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Conclusions

• Non-specialized substance abuse treatment
  programs were able to address the needs of their
  AI patients, although the type and intensity of
  services offered could be improved
• Further examination is needed to understand how
  factors such as culture, ethnicity, geography,
  and acculturation within mainstream American
  society affect AI responses to treatment
• Disparities in access to treatment may be more
  critical issue (gap between documented problems
  and number AIs receiving number in treatment)

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Limitations

• Treatment agencies not randomly selected and
  alcohol-only programs not included in study
• Self-report measures
• Insufficient program information gathered, not
  able to identify any culturally-specific
  content/activities
• Involvement with AI cultures not ascertained

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Acknowledgements

• Principal Investigator Yih-Ing Hser, PhD
• Project Director Elizabeth Evans, MA
• Statistician Yu-Chang Huang, DrPH
• Grant 1-UR1-TI11478-01, California Department of
  Alcohol and Drug Programs under the Center for
  Substance Abuse Treatment TOPPS II (Treatment
  Outcomes and Performance Pilot Studies
  Enhancement)

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